Doing the Impossible – Turning the Tide!

It’s time to do the impossible. It’s time to turn the tide.

imgres.jpgIn my last blog, I talked about the exponential potential of what could be possible if clinicians worked together in a more collaborative way. However, far more can be achieved if we work together in and with our communities to create a social movement together around being more healthy and well. I’ve talked previously about the “battle royale” that occurred between Béchamp and Pasteur over whether we should promote health or fight disease. The answer is, of course, that we need to do both, but the clinical community is not equipped with the resource or power to do it alone.

What we cannot accept, though, is our current apathy or malaise that some of the health imgres.jpgcrises we now face are too much for us to do anything about. We are in the midst of a battle, which we are currently losing and it is time to gird our loins for a turning of the tide. Here in Morecambe Bay, we have started a conversation, not just among the Clinical Community but with the wider population about how we might become the healthiest place in the UK. Yes, we mean this in a very holistic way, but there are also some specific foci we have so we can together reverse some of the appalling health statistics we are facing.

For too long, we have simply laid down and allowed exercise to be taken out of schools, whilst our kids consume a bath full of sugar every year. All the time our own work and eating habits have become significantly unhealthy. We have relied on expensive drugs to fix our problems, rather than tackling the root causes of our excesses. It has lead to 1 in every 5 pounds in the NHS being spent as a direct result of our lifestyles and 1 in 11 pounds being spent on diabetes. We say we value the NHS above anything else as a nation (maybe an issue in it’s own right…..) but we do not behave in ways that show this value to be true. We have not been brave enough to challenge the status quo and together make a wholesale change both about how we promote health and look to aggressively reverse it when things begin to go wrong.

images.jpgI suggest that within a generation, if we wanted to, we could render Type 2 Diabetes a rare diagnosis. We can do this through encouraging far more healthy lifestyles in our children and young people now, like running a mile a day and learning to eat food that doesn’t actually harm them! I believe we could significantly reduce the need for so many people to be taking medication for hypertension and diabetes now, prevent many strokes and heart attacks, by being violent towards these conditions with major changes in lifestyle, though diet and exercise, rather than the prescription of drugs, using coaching, peer support and local champions to give psychological motivation and encouragement. We are beginning to have some excellent discussions and develop some exciting plans around this.

Our NHS health checks should serve as a major motivational opportunity for someone toimgres.jpg pull themselves back from the brink of a lifetime of medication and we should use all medication reviews as a chance to help people adopt lifestyles that might reverse the need for such drugs. In the process, we would also significantly reverse our number of cancer diagnoses – many of which are linked to our lifestyle choices. We simply can’t afford for our current and failing approach to continue. We need to be braver together! And this means the NHS must be willing to partner in new ways, not only with local people, but also with businesses like the major supermarkets to help reverse our current direction towards the abyss, in which there is no longer a healthcare system that serves the needs of everyone, no matter where they come from or how much they do or don’t earn.

Don’t get me wrong! We should absolutely use medication to its fullest use for those who are at risk and have not responded to major lifestyle changes. For example, we can wage war on Atrial Fibrillation, ensuring far more appropriate use of anticoagulation, in the most cost effective and safest way, therefore preventing many life-changing strokes in the mean time. And for those who, despite lifestyle measures, still have a high blood pressure or continue with diabetes, we should not withhold medication that would prevent major issues later on. It’s just at the moment, we’re reaching for the prescription pad too readily and not looking to reverse conditions completely before they set in. We need more education out there around the early signs of cancer, so we can hit it early and reverse it’s effects when we have a better chance. Respiratory disease is another area where we could seriously make a change. We need to think of ourselves as one big respiratory team, tackling smoking, housing damp and carpeting, whilst ensuring every person has an understanding of their condition, how to use their medication effectively and what to do when things flare up. A cohesive clinical community really could deliver something special in each of these disease areas.

We could also be a great deal more effective in how we care for the frail elderly. We don’t need anywhere near as many hospital beds. We can provide care in residential and nursing homes, avoiding double payment for beds, by shifting resource out of our acute hospitals and into the community. We need to have a far more grown up conversation about why we admit people to hospital when there is very little proven benefit of doing so.

Taking a strategic shift towards a social movement for health, significant lifestyle changes and treatment only after these things have been given serious attention, but unapologetically so once they have, we can turn back this battle at the gates and change the health of this nation for generations to come. We can undo the unaffordable situation we find ourselves in and discover together a much more healthy future.

images.pngWe can absolutely do this!! It’s going to take some serious resolve and we’re going to have to withstand the fear and pressure of some pretty powerful lobbies, like the sugar, alcohol, tobacco and pharmaceutical giants, and perhaps even the government itself, but it is time for us to do the impossible. With love, hope and faith, we can do this! Yes we need to focus on schools and work places. Yes, we need to partner with organisations we’ve never worked with before. Yes, we need a far more effective media strategy and yes, we need to allow clinicians to work very differently. But we cannot do nothing. So let’s try something a whole lot more radical. That’s what we’re going for in Morecambe Bay – not just better care together, but better health together – you can watch and wait, and see if we sink or swim, or you can join us!

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A Collaborative Clinical Community 

*Warning – this blog contains swear words (not that I’m usually a potty mouth!)

This last week we had a gathering of clinical leaders around Morecambe Bay – Nurses, Occupational Therapists, Health Visitors, Midwives, Doctors, Surgeons, Physiotherapists, Pharmacists etc. We were gathered from across primary and secondary care to look together at the financial deficit we are facing as a health community across the Bay where we are seeking to serve our population.

The debt we’re facing (a hole of around 38 million of our English pounds!) is no small thing. Most of it is historic and much of it had nothing to do with us. I spent my first eighteen months as a commissioner feeling furious at the government. I wanted to rail against the machine, the injustice of working in such an oppressive, top down and hierarchical system, which feels like being among the Hebrew Slaves in Egypt when they were told to make the same number of bricks with less resource available to them. I felt so angry with the fact that we invest so little of our GDP into health and social care compared to similar countries and when further unthought through policies were dictated from Whitehall, I felt a total rage. It doesn’t help being politically pretty far to the left and working under a regime to which I feel ideologically opposed.

But one day, I realised two things. The first thing I realised is that the government are not going to change their position or policy. Our systems of government are not set up in a relational, collaborative or solutions focussed way. It doesn’t have to like this, but this is the way it currently is. Our systems have become the very antithesis of their purpose. Rather than serve the needs of the people, the people now serve the systems. The second thing I realised was that my anger didn’t achieve anything except to make me feel tired, disempowered and stressed. I had retreated into the less healthy parts of my personality in which I was keeping false joy alive and feeling burnt out in the process.

Truth has the ability to set you free. When we face truth, no matter how painful, it gives the choice of being more free. Facing up to the truth that the government are not about to change their modus operandi and that I was feeling angry and stressed allowed me to step out of rather childish thought processes and step into something altogether more wholesome. It allowed me to step out of a false sense and rather oppressive noun of responsibility and gave me the space to think more creatively about how I am part of a community of people who can respond to the situation we find ourselves in. We can respond (verb) once we step out of the oppressive yolk of responsibility (noun).

So, those of us in clinical leadership may have not created the financial situation, but there are some stark realities for us to face up to. Whether we like it or not, our current ways of working carry much waste, caused partly by the way the finances of the system operate, but also because we have not thought of ourselves as one. There are ways we behave within the system that create more financial problems and do not serve the community as well as we could. And so it is time for us to do what we can, within our gift by being much braver in our approach. I am suggesting that there are three Cs that are vital to our future.

  1. Collaborative

imagesWe need to reimagine ourselves as all being part of a team who are together tackling the health crises we are facing. We know only too well that, as just one example among many, we are failing kids with asthma because we have not joined up our resources or thinking adequately enough. Yes there are major issues with housing, smoking and pollution, but let’s not point the finger or push the problem somewhere else. Let’s use the phenomenal brains God has given us to pull the right people round the table and work out what we’re going to do about it. Let’s change the way we spend our time so that we’re in schools, we’re listening to our communities and we’re partnering together outside of our normal comfort zones to change the health of the generations to come. We know only too well, that if we don’t shift our focus towards population health and work more intentionally with our communities, doing things with them rather than too them, we will never win this battle. We’re not about playing political games. We are about working with our communities to create optimal health for every person no matter who they are or where they are from. We need to be braver, push the boat away from the shore we know and face the uncertain waters of working altogether differently. In my next blog I will explore some of the possible ways we could work differently.

2) Clinical

In order for the NHS to adapt and become sustainable for the future, we must not be afraid of clinical leadership. Our managers have a phenomenal set of skills, which we must draw on, but there is a trust we have amongst the communities we are embedded in that means they will trust us, if we engage with them properly that will allow us to turn this ship in a new direction. We must partner with our managerial colleagues, but be braver about the direction in which we know deep down we need to head in. We have gained so much expertise and trust and this is not a time to waste it or bury our heads. We must be braver and bolder in our vision of what we can really achieve together.

3) Community

iuAs clinicians we must, as many have stated this week, build bridges not walls. There is far too much division, suspicion and competition amongst us. (Here comes the swearing)…..I was in a conversation with a consultant colleague recently and he was relaying to me that another consultant referred to GPs as a “bunch of Fuck Wits”. In a separate conversation, one of my GP colleagues referred to consultants as a “bunch of arrogant Shits”. These kind of attitudes pervade the NHS and have created a culture of dishonour, distrust and division. Honestly! We’re better than this. How are we going to create the new workforce of the future that works across our currently artificial boundaries if we don’t teach them basic respect? This week a patient came to see me because he was dismayed at having to have seen a nurse at the hospital after suffering a significant condition and wanted to check that I, as a doctor, was happy with what he had been told. I could have laughed it off, but I wanted to stand up for my nursing colleague, who actually has far more expertise in this area of medicine than I do. The advice he had been given was perfect and completely in line with the best guidance available. We must not be afraid to challenge attitudes that are antiquated and out of place. More than ever, we need a culture of honour. A culture of honour is one in which we believe the best of each other, speak well of each other and appreciate our brilliantly necessary but differing gifts and expertise. We need to work out how we work effectively together for the best of the people we serve. We need to connect with each other and rehumanise the system in which we work. When was the last time you met as a cross cultural or multidisciplinary team and simply told each other what you love and appreciate about each other and the work you do? If we can’t learn to be more relationally whole, we will continue to work in the midst of serious dysfunction and strife. Come on – amongst us we have some remarkable gifts of wisdom, healing and hope. Let’s build the kind of culture and community amongst us that stands shoulder to shoulder, changes the story in the media and speaks with one voice to the powers that we are about the a new way of working together through relationship not hierarchy and fear. What might we really achieve together? It is this kind of collaborative clinical community that can change the future of healthcare, not just in the UK, but right across the globe.

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How To Forgive

forgive[1].jpgMany of us feel that forgiveness is a good idea or it is something we would like to do, but when it comes to actually forgiving someone, it can be hard to know how to go about it. In my last vlog I talked about the extraordinary and healing power of forgiveness and how it helps us to be more healthy and well. In this vlog, I talk through a straight-forward process that helps us to actually be forgiving.

 

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The Extraordinary (Healing) Power of Forgiveness

images.jpgThere are many times when people come to see me, as a GP, and I cannot find a physical cause for their pain. There are various other conditions when people have what we call “medically unexplained symptoms”. For others, they can get stuck in a rut with their mental health and feel unable to get out of it. In the west, we are not as comfortable as we might be in dealing with the concept of spiritual health. Our spirit, the true essence of who we are, can also suffer damage and ill health, which in turn can lead to physical and psychological manifestations of that same pain. One of the things I have seen time and again as one contributing factor is when someone is finding it difficult to forgive a past hurt. In this vlog I talk about the great power of forgiveness in helping us to be more well. In the one after this, I will talk about how we can actually go about forgiving someone who has hurt us.

 

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A Healthier Story

So, we start 2017 with General Practice “skating on thin ice”, the NHS as a whole “creaking on the edge” and major concerns over funding and waiting times. Why don’t we step outside of that rather repetitive and boring story, and find a new one together – one that resonates far more with the ancient paths we once knew?

 

The world is changing, and not in a good way. We are becoming more separated from each other, our organisations and systems dehumanise us and we are becoming less well. The story that the ‘benevolent hand’ of the free market will work everything together for good is exposed in it’s nakedness, like the Emperor’s new clothes. The fabric of our society is unwinding as we become more disconnected from our own sense of wellbeing, our communities and the land on which we live.

 

How do we recover a sense of wellbeing? Where will we find healing for our past, present and future? How can we expand our own vision of what it means to be well, focusing not only on our physical health, but also on our mental, spiritual, social and systemic health?

 

How might the General Practice community move from being a group of health heroes, who fix people when they are unwell, to letting go of that old and unsustainable paradigm, learning instead to co-host, with others, an environment in which a community can be healthy and well? It doesn’t mean doing away with skills that have been crafted, but using them to empower others to be partakers and not only recipients. What if GPs or ICCs (Integrated Care Communities) faced up to the fact that they don’t have all the answers, nor the resources, nor the power to fix the problems in their local populations? What if they allowed themselves to become more of a part of their community, rather than separate or slightly aloof from it? What might a co-operative model look like? If every patient owned a small share of the practice and it truly ‘belonged’ to the community, just how radically might things change, without the need for huge ‘take overs’ by local hospital trusts or private healthcare firms? If we are to find a new way forward, we must all be willing to let go of what we have known and the power which we hold. We have to let go of our need to chase the money and imagine that we are like the city of Detroit, declare ourselves bankrupt, financially and spiritually and then together, break down the walls that keep us separate and find our way together.

 

When we host spaces in which communities can come together, rather than trying to be the experts who know how to fix everything, we let go of our need to be the heroes and come into a space for shared learning. As I spend time with a community of people recovering from various addictions in Morecambe, I find I don’t have the tools to fix things. However, I do find, that together there is a huge heart for a better and more healed society for everyone, so that others do not need to find themselves in the grip of addiction. We need to know less and find more corporate wisdom. We need to share our gifts and find the beauty of reciprocity – that it is in the giving and receiving of one another that we find a way forward in positive peace.

 

The future of our health and wellbeing relies far more on our interconnectedness and our community than on the systems we have built. Our systems must give way to become subservient to the longing of our hearts rather than the task masters which drive how we organise ourselves and live out our lives. Co-operative community gives us an opportunity to live something much more radically loving and kind, in which people and the planet really matter. Today is epiphany! A day in which some people with real wisdom realized that God came as a baby, weak, helpless and in need of community for health, wellbeing and development. If God is and needs community, how on earth have we become so disconnected from that story and made our whole way of being about experts and empires? Here is an epiphany for 2017. If God did not come as an imperial expert, but in weakness and humility, we need to do the same, if we are to find any hope for the future. The system will not change from the top down, it’s too invested in the broken story to be able to do so. But we, the people, can together be cogs that turn in new ways and realign ourselves with a way of being that brings better and more holistic health for everybody, everywhere.

 

 

Here is another interesting blog, from a slightly different perspective about how community really is the future of medicine – well worth a read, when you can make space for a nice cuppa and some left over Christmas cake (good for your wellbeing)!

 

The Future of Medicine is Community

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Making Healthy Choices for the New Year!

So……a new year…..some new resolutions? How about some health resolutions? Given the health crisis we are facing, if you could change one thing over the next 6 months, what would that be? And if you did change something, how would you know it was being beneficial? What would you notice? What would others notice? How would you know you were progressing up your ‘ladder of success’?!

 

Come on, now! You can do it! What would you like to focus on? Would it be exercise? What would be realistic for you? Walking for 10 minutes three times a day at a pace that gets you out of breath? What about taking a leaf out of the books of children all over the UK in running a mile a day – it only takes about 15 minutes?! Or how about seriously reducing your sugar intake or the amount of alcohol you drink? What is your focus going to be?

 

Think in a solutions focused way! You don’t have to make unrealistic goals or promises you are going to break next week. Be honest with yourself. Think about what the barriers and pitfalls might be and get prepared for them. Your inner chimp has had too much control and it’s time you lived out your values this year. (Read the Chimp Paradox by Steve Peters). What is your number one health value? Feed that value to your mind every day as you wake up and when you go to sleep, so that you can re-program your brain and get living in line with what is important to you! Two of my values for this year are that I value being active and I value feeding my body with things that benefit my health.

 

So, let me give you an example of how you can work this up on your own, to have goals that you can achieve. Firstly, choose the thing you want to change. So, I might say, I want to do 3 lots of 10 minutes of exercise every day. Does this feel achievable? Yes – I think so, but I won’t beat myself up on days where work is crazy or the kids are sick. But I am going to make a determined effort to ensure work does not stop me being healthy. OK, so what will I notice if I am doing more exercise? I’m going to challenge myself to make a list of 10 benefits:

 

1) I will be able to fit back into my favourite jeans.

2) I will feel less breathless when climbing stairs – now I challenge myself and instead of using a negative (I will feel less), I try and phrase it in a positive way – I will have more energy when I climb stairs.

3) I will have more focus in my work because I will have cleared my head with a midday walk

4) I will be more fit

5) I will be looking in better shape

6) I will have more energy to play football and other sport with my kids

7) I will feel more alive and active and I will know this because I will be breathing more easily

8) I will enjoy walking with other people and talking with them

9) I will be sleeping better

10) I will have less back ache, as I will be losing weight

 

Ok – so what will other people notice?

 

  1. My wife will notice I have more energy and zest for life
  2. My kids will notice I am playing more actively with them
  3. My patients will notice that I practice what I preach
  4. My colleagues will notice that I am more present in conversation because my head is more clear
  5. My friends will notice that I’m taking my health seriously
  6. My wife will notice I’m in better shape
  7. My wife will notice I’m snoring less and waking up more refreshed
  8. My kids will notice we start going for more walks after dinner and at weekends
  9. My family will notice we are spending more time together being active, no matter what the weather
  10. My friends will notice I am more relaxed and happy

 

And the next step is really simple. All I have to do is simply recognise ANY time ANY of those things happen and it will encourage me on my journey of change. The secret is this: We have to imagine another way of being, paint as much colour onto that canvas as possible and slowly watch that picture emerge in our lives as we take hold of the future we actually want. It’s not the power of positive thinking. It’s the power of acting in line with positive choices we are making. Come on! Let 2017 be the year when you made a choice and acted in line with it! Put your chimp in it’s cage, stop making your excuses and be a more healthy you!

 

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Wake Up to Our Health Crisis

imgres.jpgIt’s all over our news today – our health is in a real mess, and this is our wake-up call moment – we really do need to take it seriously. It’s all very well us protesting about the under-funding and under-recruitment in our NHS (and we are right to do so), but we can no longer shy away from the burden our own health choices are planting on the NHS. I’m telling you, it’s a mess and we have to do something, because genuinely, if we don’t there won’t be an NHS left for our children or their children. We simply cannot afford for 80% of us aged 40-60 to be overweight, exercising too little or drinking too much alcohol. We cannot afford to be spending 1 in every 5 pounds in the NHS as a direct result of our lifestyles or 1 in every 11 pounds on diabetes.

 

http://www.bbc.co.uk/news/health-38402655

 

images.jpgDo you know who doesn’t care? The sugar giants – they don’t care – they are more than happy to keep our kids eating a bath-full of sugar every year, and they are more than happy to take the lovely tax breaks from our government and not even contribute to the cost our NHS picks up on their behalf. The Chocolate industry – they too are pretty happy that chocolate is no longer a luxury (people used to have it as a real treat) and that we are so willing to turn a blind eye to the fact that their empires are built on the slavery of children, whilst we fulfill our insatiable greed. Who else doesn’t care? The Alcohol industry – they do not care that every time you drink one pint of beer, you are eating the equivalent of 16 fingers of kit-kat in one go – so a night out with 4 pints is 64imgres.jpg fingers of kit-kat in one evening – think about it! And by the way, they don’t pay their fair share of tax either, and yet what they cost our country is far more than they contribute. ….Then let’s not even go there with the huge Pharmaceutical giants, who are rubbing their hands together at the thought of how many of us will be prescribed medication for blood pressure, cholesterol and diabetes over the next couple of decades, when we could all do without most of it, if we made some simple changes now! And what of the Fast Food outlets that cram our high streets with ill-health choices – who makes these decisions about town planning?!

 

imgres.pngSo, if these corporate giants don’t care, we should care – and maybe we haven’t until now, but it’s time we did!! And we should be pretty angry about the fact that successive governments have been on the side of greedy corporations, who are literally poisoning us. They have chosen, time and again, to support big business and the unaccountable growth of their money, above the wellbeing of their own people! And these companies have advertised the benefits of their delicacies, placed their products very carefully in collusion with the Supermarket giants and who are the fools who believed it all? That would be us! But we must not let our anger be a cause to blame someone else. We must fess up to our own weaknesses and vices, understand them and no longer let them rule us. We have been led right down the garden path of temptation, succumb to the the idea that we’re worth it and we can have whatever we want, without thinking of the consequences…..well…..now we’re at the tipping point. So let’s wake up!

 

If you could change one thing about your lifestyle heading into 2017, what would it be? In my next blog, I’ll give you some simple ideas of things you might want to think about – but no one can make the change for you. It is time for us to make some choices about what kind of legacy we want to leave for the future. The past has caught up with us, but we can determine a different kind of future, if we are willing to make the changes now! It won’t be easy, but if we adopt the spirit of 1945, it really is possible!

 

 

 

 

 

 

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Understanding Brexit (and Trump)

I’ve been doing a bit of thinking about how the Brexit and Trump campaigns were so successful. (I owe most of ths thought process to a very inspiring session about our shadow selves from Paul and Angie Woods, during a weekend focussed on the Enneagram). What was it, apart from the arguments made and the general feeling of discontent that appealed so deeply to the national psyches of the United Kingdom and the United States respectively?

 

I think there is some real wisdom to be gleaned from the Enneagram about the corporate personalities of the UK and USA, which might help us to understand why the majority voted as they did and how we might want to understand and embrace our corporate mind-sets as we look to develop a positive politics of peace for the future.

 

Richard Rohr has done some helpful work, as have others, on the personality types or dominant psyches of various nations. I agree with his perspective that Great Britain has a Type 6 personality and the USA is of Type 3. The root struggle for a type 6 personality is the need to be secure – therefore any campaign based on fear (of not having enough Sovereignty, of not having control of our money, of the “other” people who keep coming here and taking away our sense of national identity) touches on our deepest need and struggle. For a type 3 personality, the root struggle is the need to succeed and so the promise to ‘make America great again’ strikes the chord that tugs on the heart strings.

 

enneagram-3-6-9-healthSo, focusing in on the UK (maybe some thoughts on the lovely USA another time), if we are to shift the political discourse towards something more healthy for the future, we need to learn to listen to the part of us that feels the need to be safe. We need to understand the ‘shadow’ part of our corporate personality that is anxious and fearful, admitting to ourselves what drives our thoughts and actions. When a Type 6 personality is not in a healthy place, they will begin to regress into a Type 3 pattern of thinking. So, the underlying drive to be safe becomes the need to get noticed and be special. So, post-brexit, some of which was about the need to be safe, we find our politicans trying to re-assert our Soverignty and our ‘Greatness’. Only a couple of weeks ago, Boris Johnson, the Foreign Secretary, was declaring on the radio that we don’t realise quite how the rest of the world sees us. Apparently, they admire us and think we need to continue showing great leadership in the world. We continue to believe this about ourselves, that we are very special and have a vital role which the rest of the world needs us to play. I wonder if we actually asked the rest of the world whether or not this is true, they might laugh in our face, pat us on the head and gently remind us that the world has moved on, but maybe we have not.

enneagram-6

 

Great Britain, as a Type 6 corporate personality, has an innate sense of loyalty. After the NHS, our Royal Family reamins the most popular part of our national identity, according to recent surveys. We carry a sense of being ‘loyal subjects’ who ‘do our duty for Queen and Country’. We are reliable, dependable, a safe pair of hands. But when our security is threatened, when we feel we are losing control, when we are told again and again that our borders are not safe, we begin to seek our security externally. We shut others out, we stop trusting others to make rules we don’t feel we have enough control over, build more weapons and ensure our finances work primarily for us. This then leads us towards a tendancy for workoholism, and so then we cut the nation state, drive people back into work, making an argument that it is the ‘lazy poor’ who are in part to blame for some of our mess. We become much more image conscious of our perceived role in the world and go on a charm offensive to remind people just how special we really are. But let me just state this: this is not a very healthy way to behave or live in the world.

 

I know this isn’t going to sound ‘Great’, but it is my perspective that ‘Great Britain’ left the European Union our of a place of fear, which has drawn us to try and re-discover our ‘special’ place in the world. During the referendum, some of our deepest corporate insecurities were touched on, and rather than see them for what they are, speak to them comfortingly and confront them within ourselves, we were enticed into age old patterns of behaviour which acually prevent us becoming the true gift amongst nations that we could be. You see, in my opinion, the invitation to the UK was (and actually continues to be) this: Firstly, let’s admit it – we’re scared. There is too much going on in the world that makes us feel out of control. We need a sense of comfort and security and we’re not sure how to get that anymore, without shutting our borders and taking back control over our ‘own laws and money’. This is exactly why we need the firendship and help of our neighbours! Secondly, we need to hear the call to us that we are loved, actually (!) and we can therefore allow ourselves to be still and know that safety is not truly found in better barriers and bigger weapons but in the risk that is relationship, vulnerability and being known…..that somehow underneath everything are the ‘everlasting arms’. Thirdly, this allows us to find a new place in ‘just being’, knowing we have inherent value, becoming truly loayal friends to the rest of Europe and the World, without the need to re-establish our status as the ‘Great One’.

 

Yes, the media holds an enormous amount of power, but it was the appeal to our deepest needs, a root struggles that enevitably lead to Brexit. Those, who felt the pull to remain, needed to speak to those very same issues, whilst calling us not towards our ‘3’ need to be Great and Successful, but towards our ‘9’. We must awaken the imagination of these amzing isles to a new place in the world, that is not about reassesrting our own name as Great, but finding our place as a nation of peace, building an altogether different kind of future in which our work does not look to protect our own future and rights, but the future hope of everyone everywhere. The UK has some incredible gifts and we can be a gift within and among the nations. We need a world in which each nation knows it’s inherent value and each can take their place amongst the nations to build a future for generations to come, in which we live in peace. We need to reimagine our place in the world. We need to tell a new and more ancient story. In order to do so we MUST face up to our own shadow, otherwise we will continue to act out of it and be the very antithesis of what we would, in our heart of heats, love to become.

 

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Personality Health

imgresWe often talk about physical, mental, social and even systemic health, but we don’t often think or talk about the health of our personalities. Our personalities are shaped by our self-esteem, our values, our truths, our needs, our struggles, our instincts and our gifts. They impact every part of our lives, relationships and interactions with the world at large and although we give some focus to understanding them through tools like Myers-Briggs, the Enneagram and Strengths-Finder, (perhaps to make us more successful), we give little thought to how healthy we are when it comes to this subject.

 

enneagramdisordersNow, what is particularly interesting to me as a doctor are 2 things related to this. Firstly, our personality type is hugely linked to the kind of mental health problems we might be more likely to develop. I wonder how often clinicians see the presentation of a mental illness and are able to talk with the person in front of them about which aspects of their personality might need therapy in order to help their mental health improve? As the whole area of positive psychology develops, it is vital that there are learning environments in which clinical teams can learn about innovative approaches in psychology that avoid the over prescribing of medication, especially in our younger population.

 

14516526_OPiwmgUE_c_large.jpgThe second area of interest is to do with how we can be more self-aware of how healthy we are or when we have reached a point at which we can no longer really help ourselves but need others who love us or care about to to intervene.  Below is a chart (of sorts) which I learned about during a weekend on the Enneagram. It helps to explain aspects of personality health. I recognise that at times I am functioning more healthily than at other times, due to a combination of internal and external factors. I think there are behaviours we can be aware of, or ways in which we are operating in relationships and situations which should serve as a WAKE UP CALL to us. When we notice more negative patterns, we need to take stock of where we are and work out our lines of responsibility to help us back into a more healthy state. However, if we don’t, things can continue to worsen until we reach a point at which we need others to intervene on our behalf and rescue us from our self-destructive and damaging sickness.

 

We can make a comparison with heart disease. For much of the time, our hearts MIfunction healthily. However, through a mixture of internal and external factors, our hearts can become less healthy. When this occurs, our body will fire some warning shots to us, giving us a chance to change before something more serious occurs. This might be signs and symptoms do do with our weight, nutrition, fitness, level of breathlessness, vague chest pains, markers in our blood tests – like high cholesterol and high sugar, rising blood pressure etc. However, if we ignore the opportunities to change and continue with our unhealthy choices, eventually we will reach the point at which we have a significant event, e.g.the start of angina, a heart attack, a stroke, the development of diabetes. At that point we need the help of someone else – we can no longer do it on our own. Of course, we still have choices and can reject the help on offer, but if we do, we risk our own demise and ultimate death.

 

images.jpgMy point is this. If we do not take the health of our own personalities seriously, there are serious and significant consequences, not only to ourselves but those around us and the world we live in. Many of us reach a point when we need help, but might not even face up to this, due to the poor health we are in. In those times, we need those who love and trust to be brave enough to reach in and offer us a life line. We may have even reached the place where we need resuscitation, when all our pride has gone. When we have ignored the red flag, we need those around us who will risk our total rejection of them to love us enough to offer us a way back to health. We need to take the health of our personalities seriously – it actually has a huge bearing on all the other aspects of our health. We also need

 

enneagram-health

 

HEALTHY

  • 1. Level of Liberation – Ego transcended – balance/freedom – i.e you become a gift
  • 2. Level of Psychological Capacity – Ego as particular mode of being – choice of how to be
  • 3. Level of Social Gift – Ego operating in constructive way – sublimating ego

 

Wake up Call – need to listen to internal warning bells

 

AVERAGE

  • 4. Level of fixation – Ego role assumed – falling asleep (not self-aware) – losing contact with presence
  • 5. Level of interpersonal conflict – Ego controlling environment to support self – manipulative/defended
  • 6. Level of overcompensation – Ego inflation, demanding others and reality support it – aggressive defence

 

Red Flag – need of help from others

 

UNHEALTHY

  • 7. Level of violation – Ego willing to violate self and others to maintain itself – abusive/desperate
  • 8. Level of Delusion and compulsion – Ego loses touch with reality – out of control – personality disorder
  • 9. Level of pathological destructiveness – Extreme pathology and/or death

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Reimagining Medical Education

imagesWe’ve got a problem (well 4 actually), when it comes to medical education! The first is this: Jeremy Hunt is promising loads of new places at medical school – I know this doesn’t sound like a problem, it sounds like a solution. But the truth is, once you actually do some number crunching, the new places won’t even account for the losses we will have due to retirement over the next 10 years, let alone account for the increased need there is in the system. So…..we’re still going to be short of doctors. Unfortunately – there isn’t a political appetite to increase these numbers further, and with our exit from the EU we’re genuinely facing an ongoing crisis.

 

The next problem is therefore that we need to restructure our workforce in quite aimages.jpg creative way, to work more smartly and differently, with a flexible workforce, but due to the pressures upon the system, there is little room for people to put much time or imagination into this and there is also a huge leap of faith involved. There is simply not the evidence base in place to support the leap we are asking GPs, in particular, to take in restructuring their practices and not replace GPs with GPs, but with combinations of paramedics, advanced practitioners, physician assistants, physics, mental health workers, health coaches and the like. However, the issue is that the system finds itself, like Indiana Jones, at the edge of a cliff, with no way back and the only thing for it is to step into the unknown and hope that God supplies the stepping stones…..Those in leadership positions are going to have be given space and grace to try some things, get it wrong and try again……One of the vital things that will be involved is proper engagement with the communities we serve. Clinicians and the general population need to have a better and deeper understanding of one another. There is a huge language void to be bridged and a collaboration that is needed in understanding how services can be more helpfully redesigned for the benefit of everybody. It also means where there are are difficult decisions to be made, there are no cloak and daggers or suspicion, but honest, open communication in the light of day that builds trust and partnership.

 

Our third issue is that with the vast increase in hyper-specialism and the loss of generalism from training programmes after qualification. Rural and remote places in particular are unable to get the staff mix necessary to run successful and safe services. This is due to a lack of foresight from centralised diktats and various guidance from NICE and the Royal Colleges that favours this approach. Health Education England must be brave enough to allow areas to be innovative in the training they provide. Our needs in Morecambe Bay are utterly different to those of Nottingham or Central London and we need new training programmes that will cater for this.

 

images.jpgFourthly, our medical schools are delivering a curriculum, designed centrally but based on yesterdays NHS. There is not enough creative vision around the curriculum to build the right kind of future doctors. There is still far too much focus on illness and disease and no where near enough thought or teaching about wellness, healthy lifestyles, nutrition and non-pharmacological options. The role of the future doctor is much more population focused and digitally savvy. It is our medical schools more than anywhere else that carry the responsibility to ensure the future NHS is catered for. We need a radical shake up in medical education and some brave people to rewrite the curriculum that will enable medical schools to be more creative and engaging in helping to raise the doctors we need for the future.

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